Dear Traveler, LETTER FROM TRAVELGUARD REGARDING INSURANCE FOR TRAVEL TO CUBA At this time our current procedure for insuring travelers to Cuba has changed to align with the most current government regulations concerning travel there. Coverage for travel to Cuba can only be purchased using a direct mail or fax application. Customers cannot purchase these policies over the phone or the internet since there are multiple pieces of documentation needed to issue a policy. We also do not accept applications via email due to security reasons as they typically contain credit card information. The same plans and pricing are available to Cuba travelers as any other traveler going to any other destination. There are a few things we need in order to issue a policy to Cuba travelers, depending on Category of travel: 1) Completed Cuba Travel Certification which has been attached for your convenience. Please fill out the first page (Part 1) completely as well as the Travel Category Form (Part 2) that corresponds to your selected category of travel. A separate Cuba Travel Certification must be filled out for every traveler regardless of age or household. 2) A completed physical application that MUST be signed by the customer. Travel agents or other parties cannot sign for them. I ve attached a copy of a paper enrollment application for your convenience. Where to send this information: Mailing address: Travel Guard: Attn Administration 3300 Business Park Drive Stevens Point, WI 54482 Fax: 1.800.955.8785 1.715.345.2915 Again, due to compliance and credit card security reasons please do not email any of these forms to us. If you have any further questions, please don t hesitate to call TravelGuard s Cuba department at 866-375-2546. Kind Regards, Travel Guard
CUBA TRAVEL COMPLIANCE CERTIFICATION Part 1 I am a United States citizen, a United States permanent resident or a person currently residing in the United States and, as a condition of receiving the travel insurance provided herein, I represent that I am eligible to travel to Cuba under one of the following categories: Select applicable category: o o Family visits ( 515.561 certification) Official business of the U.S. government, foreign governments, and certain intergovernmental organizations ( 515.562 certification) o Journalistic activity ( 515.563 certification) o Professional research and professional meetings ( 515.564 certification) o Educational & People-to-People activities ( 515.565 certification) o Religious activities ( 515.566 certification) X Public performances, clinics, workshops, athletic and other competitions, and exhibitions ( 515.567 certification) o Support for the Cuban people ( 515.574 certification) o Humanitarian projects ( 515.575 certification) o Activities of private foundations or research or educational institutes ( 515.576 certification) o Exportation, importation, or transmission of information or informational materials ( 515.545 certification) o Certain export transactions consistent with the export or reexport licensing policy of the Department of Commerce ( 515.533 certification) o Certain export transactions ( 515.559 certification) Specific license (a copy of the license must be provided prior to purchase) o Name: (First) (Middle) (Last) Address: (No.) (Street) (City) (State) (Zip Code) Telephone Number: Email: and other identifiers I hereby certify that the above information is true and accurate. (Signature) Date:
Part 2 Section 515.567 Certification Public performances, clinics, workshops, athletic and other competitions, and exhibitions (a) General license for amateur and semi-professional international sports federation competitions. The travel-related transactions and such other transactions as are directly incident to athletic competition by amateur or semi-professional athletes or athletic teams traveling to participate in athletic competition in Cuba are authorized, provided that: (1) The athletic competition in Cuba is held under the auspices of the international sports federation for the relevant sport; (2) The U.S. participants in the athletic competition are selected by the U.S. federation for the relevant sport; and (3) The competition is open for attendance, and in relevant situations, participation, by the Cuban public. (b) General license for public performances, clinics, workshops, other athletic or non-athletic competitions, and exhibitions. The travel-related transactions and such other transactions as are directly incident to participation in a public performance, clinic, workshop, athletic competition not covered by paragraph (a) of this section, non-athletic competition, or exhibition in Cuba by participants in such activities are authorized, provided that: (1) The event is open for attendance, and in relevant situations participation, by the Cuban public; (2) All U.S. profits from the event after costs are donated to an independent nongovernmental organization in Cuba or a U.S.-based charity, with the objective, to the extent possible, of promoting people-to-people contacts or otherwise benefiting the Cuban people; and (3) Any clinics or workshops in Cuba must be organized and run, at least in part, by the authorized traveler. Example: An amateur baseball team wishes to travel to Cuba to compete against a Cuban team in a baseball game in Cuba. The game will not be held under the auspices of the international sports federation for baseball. The baseball team s activities therefore would not qualify for the general license in paragraph (a). The game will, however, be open to the Cuban public and any profits after costs from the game will be donated to an independent non-governmental organization in Cuba. The baseball team s activities would qualify for the general license in paragraph (b). (c) An entire group does not qualify for the general license in paragraph (a) or (b) of this section merely because some members of the group qualify individually. I have read the foregoing and certify I meet these requirements: (Signature) Date:
TRAVEL INSURANCE ENROLLMENT/APPLICATION FORM 1 ENROLLMENT/APPLICATION 2 PLAN COST CALCULATION* TRAVELER 1: BASIC SILVER GOLD PLATINUM * First Name * Last Name * Middle Initial 1 TRAVELER NAME BIRTH DATE TRIP COST PLAN COST * Gender * Address1 * Address2 * City * State/Province * Zip/Postal Code Phone ( ) * Email Beneficiary * Destination Country * Destination State/Province * Airline * Cruiseline * Tour Operator * Car Rental Provider * Trip Deposit Date * Departure Date * Return Date 2 3 4 T O TA L 3 $ 7 SERVICE FEE * For more information, please contact your travel agent. All travelers listed on this plan must reside at the same address. If any travelers reside at a different address, a separate policy must be purchased. 4 PAYMENT INFORMATION Check or Money Order Payable to Travel Guard American Express MasterCard VISA Discover/Novus Expires / Name of Cardholder Please review the Certificate of Insurance/Policy provided with this enrollment form or at: www.travelguard.com/xxx for full terms, limitations, and exclusions. + Agent Name/Initials *Required Information AGENCY CODE I acknowledge that I have read, understand, and agree to the terms and conditions of this coverage as detailed in the Certificate of Insurance or Policy. For more information: Contact your travel agent or complete and mail in this enrollment/application form to: AIG Property Casualty 3300 Business Park Drive Stevens Point, WI 54482 Signature Date 5/1/14 EN NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA. Executive Offices: 175 Water Street, 18th Floor, New York, NY 10038